Casey Yossa, Dean Healy, Satish Muluk
Cardiovascular & Thoracic Surgery, West Penn Allegheny Health System, Pittsburgh, PA.
OBJECTIVES: According to NKF-DOQI guidelines, brachiobasilic fistulas (bbfs) are the next best alternative if a radio- or brachio-cephalic fistula cannot be successfully created. However, there are few current, large series in the literature examining their outcomes. Our objective was to review our experience with bbfs, including the factors affecting functional patency.
METHODS: We reviewed 134 consecutive bbfs performed over a period of 5 years. We recorded demographics, comorbidities, time to access, and functional patency. Data were analyzed by chi-square, life-table, and proportional hazards modeling.
RESULTS: Fifteen patients were either lost to initial follow up (n=6), died (n=8), or received transplant (n=1) before dialysis was attempted. Among the remaining 119, mean follow-up was 22 months. Three bbfs were ligated early due to steal and 25 failed to mature. 91 bbfs (76%) matured to successful dialysis. Of these, median time to first access was 6 weeks (mean 6.4 weeks). By life-table analysis, median functional primary patency was 41 months, while median primary assisted patency was 49 months. The only significant factor predicting increased primary patency was female gender (Figure). Diabetic patients exhibited a non-significant trend toward shorter patency. BMI, age, and smoking were not predictors of time to failure.
CONCLUSIONS: This large series shows that bbfs can yield acceptable long-term functional outcomes with maturation rates higher than those generally reported for forearm fistulas. The procedure appears to be especially valuable in females, and outcomes are not adversely affected by elevated age or BMI.
AUTHOR DISCLOSURES: D. Healy, Nothing to disclose; S. Muluk, Nothing to disclose; C. Yossa, Nothing to disclose.
Posted April 2012